@article {Rose291, author = {Louise Rose and Erind Dvorani and Esha Homenauth and Laura Istanboulian and Ian Fraser}, title = {Mortality, Health Care Use, and Costs of Weaning Center Survivors and Matched Prolonged ICU Stay Controls}, volume = {67}, number = {3}, pages = {291--300}, year = {2022}, doi = {10.4187/respcare.09438}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Quantification of long-term survival, health care utilization, and costs of prolonged ventilator dependence informs patient/family decision-making, health care policy, and understanding of specialized weaning centers (SWCs) as alternate care models. Our objective was to compare survival trajectory, health care utilization, and costs of SWC survivors with a matched cohort of >= 21-d-stay ICU patients.METHODS: This was a retrospective longitudinal (12 y) case-control study linking to health administrative databases with matching on age, sex, Charlson comorbidity index, income quintiles, and days in ICU and hospital in preceding 12 months.RESULTS: We matched 201 SWC subjects to 201 prolonged ICU survivors (402-subject cohort); 42\% had a Charlson score of \> 4. Risk of death at 12 months was lower in SWC subjects (hazard ratio [HR] 0.70 [95\% CI 0.54{\textendash}0.91]) adjusting for length of hospital admission (HR 1.02 [95\% CI 1.00{\textendash}1.04]) and number of care location transfers (HR 0.84 [95\% CI 0.75{\textendash}0.93]). By follow-up end, more SWC subjects died, 149 (73\%) versus 127 (62\%). We found no difference in discharge to home. At 12 months, acute health care utilization was comparable for the entire cohort, except hospital readmission rates (median interquartile range [IQR] 2 [1{\textendash}3) vs 1 [1{\textendash}2] d). Median (IQR) cost 12 months after unit discharge was CAD $68,165 ($19,894{\textendash}$153,475). 12-month costs were higher in the SWC survivors (CAD $82,874 [$29,942{\textendash}$224,965] vs CAD $55,574 [$6,572{\textendash}$128,962], P \< .001). SWC survivors had higher community health care utilization. Regression modeling demonstrated cost was associated with stay and care transfers but not SWC admission. Over 12-y follow-up, health care utilization and costs were higher in SWC survivors.CONCLUSIONS: SWC admission may confer some medium-term survival advantage; however, this may be influenced by selection bias associated with admission criteria.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/67/3/291}, eprint = {https://rc.rcjournal.com/content/67/3/291.full.pdf}, journal = {Respiratory Care} }